Essentials of Athletic Injury Management 10th Edition Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Chapter 11: Understanding the Basics of Injury Rehabilitation Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Therapeutic Exercise Versus Conditioning Exercise Exercise used as part of a rehabilitation program Conditioning Exercise Activities that are used to minimize injury and maximize performance Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Philosophy of Athletic Injury Rehabilitation Majority of injuries do not involve long-term rehabilitation programs Long term rehab requires supervision of highly trained professionals Coach should rely on athletic trainer to design, implement, and supervise rehabilitation Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Swelling and pain control should be provided immediately Coach can be involved initially in application of first aid Goal of athlete Return to activity as quickly and as safely as possible Must be prudent in decisions regarding aggressiveness of treatment and rehabilitation A mistake in judgment could hinder the athlete’s return Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Basic Components and Goals of a Rehabilitation Program Must address several basic components Short term goals Provide correct and immediate first aid to control swelling Control pain Restore full ROM Restore core stability Restore and increase strength, endurance and power Re-establish neuromuscular control and balance Maintain levels of cardiorespiratory fitness Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Providing Correct First Aid and Controlling Swelling Initial first aid is critical Should be directed towards swelling control Utilize the PRICE principle Each factor is critical in limiting swelling Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Controlling Pain Pain dependent on the severity of the injury, athlete’s response, perception of pain and the circumstances PRICE and additional modalities can be used to help modulate pain Pain can interfere w/ rehab and therefore must be addressed throughout the rehab process Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Restoring Range of Motion Injury to a joint will always be associated w/ some loss of motion Due to contracture of connective tissue or resistance to stretch of musculotendinous unit Athlete will need to engage in dynamic, static or PNF stretching activities to improve flexibility Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Restore Core Stability Involves strengthening the lumbopelvic region and is critical for dynamic functional strength and movement Without proximal core stability, distal extremity function becomes compromised Core strength & power must be emphasized early in the strength training program Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Restoring Muscular Strength, Endurance, and Power Essential factor necessary when restoring function of a body part to pre-injury status Variety of techniques can be utilized Isometrics Progressive resistance Isokinetics Plyometrics Emphasize work through a full ROM Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Progressive Resistance Exercise (PRE) Isometrics Performed in early part of rehab following period of immobilization Used when resistance through full range could make injury worse Increase static strength, work to decrease/limit atrophy, create a muscle pump to decrease swelling Progressive Resistance Exercise (PRE) Can be performed using a variety of equipment Utilizes isotonic contractions to generate force while muscle changes length Concentric and eccentric strengthening exercises should be utilized Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Incorporated in later stage of rehabilitation process Isokinetic Exercise Incorporated in later stage of rehabilitation process Uses fixed speeds w/ accommodating resistance to provide maximal resistance throughout ROM Speed of movement can be altered Commonly used as part of the criteria for return to functional activity Plyometric Exercise Incorporated into later stages of program Use quick stretch of muscle to facilitate subsequent concentric contraction Useful in production of dynamic movements Associated with muscular power Generation of force rapidly – key to successful performance in many activities Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Re-establishing Neuromuscular Control Neuromuscular control is mind’s attempt to teach the body conscious control of a specific movement Relies on CNS to interpret and integrate sensory and movement information and then control muscles and joints to produce coordinated movement Re-establishing neuromuscular control requires repetition of same movement until it becomes automatic Progression from simple to difficult task Functional exercises are critical for re-establishing control Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Regaining Balance Ability to balance and maintain postural stability is essential to reacquiring athletic skills Program should incorporate functional exercises that involve balance training Failure to include balance training may predispose the athlete to re-injury Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

When balance is challenged the response is reflexive and automatic The primary mechanism for controlling balance occurs in the joints of the lower extremity Lack of balance or postural stability  lack proprioceptive and kinesthetic information or muscular strength  limits ability to generate response to disequilibrium A rehabilitation plan must incorporate functional activities that incorporate balance and proprioceptive training Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Maintaining Cardiorespiratory Fitness Single most neglected component of rehabilitation When injury occurs athlete is forced to miss training time resulting in decreased cardiorespiratory endurance Alternative activities must be substituted that allow athlete to maintain fitness Put into rehabilitation program as early as possible in rehabilitation program Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Functional Progressions Progressive activities designed to prepare the individual for return to sport/activity Sport-specific skills are broken into components Athlete works to reacquire skills over time Incorporate into treatment as early as possible Athlete’s physical tolerance must be monitored If pain and swelling do not arise, the activity can be advanced Assists injured athlete in achieving normal, pain-free ROM, strength and neuromuscular control Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Functional Testing Uses functional progression drills for the purpose of assessing the athlete’s ability to perform a specific activity Entails a single maximal effort to gauge how close the athlete is to full return Pre-season baseline testing for comparison post injury Variety of tests Shuttle runs -Vertical jumps Agility runs -Balance Figure 8s -Hopping for distance Cariocca tests -Co-contraction test Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Using Therapeutic Modalities Incorporated into rehabilitation program as adjuncts to exercise Cryotherapy and thermotherapy Ultrasound and electrical stimulation Massage and traction Require special instruction and supervised clinical experience Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Ice Packs (Bags) Used for minimizing swelling and providing analgesia following injury Ice may be flaked or crushed and will be encapsulated in wet towel or plastic bag Both are easily moldable to body Elastic wrap generally utilized to secure pack in place for 20 minutes Compression and elevation are also used in conjunction with ice Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Hot Packs Used post-acutely (after swelling stops) Increase blood flow Facilitate reabsorption of injury by-products Useful as analgesic and for relaxation effects Be careful not to use too soon in healing process Cold should be used for first 72 hours post- injury Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Moist heat packs (hydrocollator packs) Silicate gel in cotton pads Maintained in thermostatically controlled hot water (160oF) Retain water and relatively constant heat for 20-30 minutes Requires the use of 6 layers of toweling to avoid burning patient Athlete should not lie on top of pack Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Criteria for Return to Full Activity Rehab plan must determine what is meant by complete recovery Athlete is fully reconditioned Regained full ROM, strength, neuromuscular control, cardiovascular fitness and sports specific functional skills Athlete is mentally prepared The decision to return to play should be a group decision (sports medicine team) Team physician is ultimately responsible Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.